Questionable Visions

The belief in witches runs deep. People don't often talk of their beliefs openly but when the subject comes up storytelling begins slowly and then crescendos; contributions follow progressively shorter pauses and the terror quotient increases, leaving everyone present either wide-eyed or nodding knowingly. Most Malawians if pressed will admit to believing in witches regardless of their educational level and/or the fervor of their affiliation with a brand of western religion.

There are the well-known comical stories, which people tell with straight faces but are hard to hear without erupting into hysterics. One friend told me about his encounter with "Bottle Man" - a sort of street performer from the sound of it. He would draw a crowd, ask for money, and then somehow shrink down and get inside a Coke bottle. I had to ask, of course, if anyone ever picked up the bottle to shake it or examine it, and he said the crowd was so horrified that the thought never crossed anyone's mind. Another personal favorite is the story the man who shrunk 60 cattle and tied them to a handkerchief, which he slipped in his pocket before boarding a minibus. Once aboard, the minibus acted as though it was extremely overloaded, sagging to the ground and unable to move. Perhaps suspecting something, the driver then had everyone disembark and searched until the culprit - the man with 60 cattle in his pocket - was caught red handed. I have no idea how the Cattle Man was reprimanded but the implication was that his cattle were not allowed to board and the minibus drove happily into the sunset. To add to this collection are the many stories of witches who fly through the night sky, crossing the continent in moments and always returning before dawn. Their "airplanes" of choice are large wicker baskets usually used for storing grain. Several stories, reported with true journalistic candor, of such "airplane" crashes have made their way into the national newspaper recently.

There are other more frightening stories. One close friend told me of an experience he had as a child of being haunted night after night by a neighbor. The neighbor would appear to him completely naked with menacing expressions, even while he was in the company of his parents and friends. After almost a year of sleepless nights and numerous incidents of describing with terror the approach of this man, whom no one else could see, his well-educated father took him to a traditional healer. From that time on the visions stopped but the haunting permanently damaged his parents' relationship with the neighbor.

Finally, there are the most horrific stories involving murder and trafficking in body parts. Whether or not people chose to belief in the power of black magic and the "success" of its practice, horrific physical evidence exists to confirm its existence. Mutilated bodies found with missing eyes, or fingers, or various internal organs cannot be shrugged off as easily as Cattle Man.

Often when I hear these stories, particularly the comical ones, my reaction is, "You know you're Western when . . . you're the only one in the room with a smirk." But, I believe in questioning judgments and when I thought about it, realized that our Western minds have room for our own brand of ghosts and witchcraft. I imagine that in any room of Americans the percentage of people who may, albeit hesitantly, share stories of ghosts seen or personal unexplained spiritual experiences probably approximates the percentage of Malawians who believe in witchcraft. The difference seems to be that in Malawi this world of spirits is mostly dark and that there is an entire subpopulatiopurporttches who perport to be able to control and/or sell services of this other darker world.

For those who would avidly deny the possibility of any unscientific phenomena, I can say that belief is powerful on both sides (for the believers and unbelievers) and denial is possible in both camps. I remember years ago watching a television program in my aunt's house about the human mind. The narrator was talking about how when we see something that only deviates slightly from what we expect, our mind interprets said item or event to be the expected item or event. In order to illustrate this, a series of playing cards was flashed quickly across the screen and the viewer was asked to say the face of each card. Eight of Diamonds, Six of Spades, Seven of Clubs and so on. The same series was repeated slower and slower but it wasn't until each card remained for a full second or longer that I realized that the Eight of Diamonds was really a red Eight of Spades and that the Seven of Clubs was really a black Seven of Hearts, etc. Doesn't that little test allow for the possibility that we see and experience things that, "should not be," and so we quickly and subconsciously rationalize events and file them away as "normal." That test really stuck with me and every once in a when it comes to mind, it helps me question to my personal truth, whether in regard to how I perceive an individual's personality or a broader more abstract concept such as witchcraft.

Along the same lines, in our developed world so much of our accepted reality is as well understood as magic. I know that if I really wanted to, I could discover how a telephone works. I don't really care to know, but the knowledge that this information exists is enough for me to believe and accept the telephone as a non-magical technology. Although, when I think of speaking to my parents on the other side of the Earth with only a fraction of a second lag-time, it is just as magical as flying in a wicker basket across Africa. During the time of Colombus the physical potential for a telephone existed, science just had to catch up to enable the reality. Could it not be possible that science just has to evolve a bit more to encapsulate and prove the phenomenon of black magic? Could it not be possible that black magic developed from a different path that is actually longer but just as linear and true as western science?

It is difficult to step aside from our way of thinking as the only way or the best way. Most of us, myself included, see our way as the best way, at least subconsciously. Most of the time I walk through life believing I have an open mind but I have to laugh at myself when I smack up against the hard borders of that openness. Who erected that border? With what assumptions? Can it be redrawn? . . . Just thoughts.

No Rain

I'm sitting in an office on the grounds of Kamuzu Central Hospital typing this up. I can hear wailing and singing from the mortuary next door and the sky, which should be dark and heavy with the promise of rain is blue blue blue. The first rains should have come late October. I suppose officially they did come, midway through November. People celebrated and began planting but the rains stopped. Now it's mid-December and Lilongwe is sweltering. I'm sure that whatever bits of green pushed through the earth have now dried and withered back to the red dusty crust. People speak only of the absent rains and the heat. Rain is everything. Rain is hope and life.

Yesterday I was assigned to theatre at Bottom. I went in to receive a baby with cord prolapse and came out with two very small but screaming little boys. I returned to the labor ward for a while and ended up next to a woman whose baby's heart rate kept dropping, but when we called theatre to see if an emergency section for fetal distress would be possible, we found that they were in the process of sectioning another woman. That woman's baby had died in-utero because she entered labor with her baby in an impossible position and didn't get to the hospital in time to have a section while the baby was still alive. I was called back to theatre to receive her dead baby and the dead baby of a 24 year-old woman whose uterus had ruptured after spending three unsuccessful days with a traditional birth attendant. I wish all of you, midwives, physicians, watchers of ER, Americans, could just catch a glimpse of the theatre.

The room itself is small and basic. One wall has windows that open to the outside, though which cracks of daylight and fresh air seep in. A simple bed occupies center stage and a small resuscitare without an overhead heater for the baby stands off to the side. There is a machine for monitoring the patient's vital signs and an electrical suction for the woman. A small foot pump suction sits next to the baby's resuscitare besides two oxygen concentrators . There is a cabinet for various syringes and tubes, a sink, a baby scale, and a couple tables holding gloves sutures, sterile packets, and other assorted items. As for the staff, all of us are gowned in theatre attire made from jean material. Everything is reusable - except for the hats and shoe covers which are always in short supply. Often we use plastic aprons tied around our heads and feet - picture everyone with white garbage bags on their heads and feet. Other times old patient gowns (donated, I imagine, by people who logically envisioned these gowns being used by patients) are used by surgeons when they run out of theatre attire. Sterile draps are also made from the jean fabric and many have quite a few holes. The scene strikes me alternately as commical, a bit depressing, or as a great illustration of people's inventive solution to lack of resources, depending on my frame of mind.

Half-way through the surgery yesterday, the shifts changed so a new anestethist came to replace the one who worked during the day. He received a few laughs as he entered the theatre. His creative solution to the absence of theatre hats was to use a carboard box. (Despite the laughs he didn't change his "hat.")

Lwanja, the senior clinical officer on staff conducted the surgery. After the intial cut through her abdomen the baby's hand emerged, confirming a severe rupture, and a stench filled the room confirming necrosis.

Throughout the surgery the theatre nurse just kept saying, "Poor, Malawians, poor, Malawians."

The room soon filled with flies and I wondered momentarily why there are never flies in the hospitals in the US.

Everything went smoothly and everyone agreed that she was lucky. She is 24 years old, she came close to losing her life but she didn't. She lost her uterus and her unborn child but she has a living child.

(When the surgery was done I returned to labor ward and found that the woman with fetal distress had delivered a healthy girl with the help of a vacuum.)

This morning I went to the hosptial to check on the woman who had the surgery and found her resting in the postnatal ward. The postnatal nurse was passing out medications and told me that the patient was all right but that her vital signs had not yet been taken today. I quickly looked over her chart and noted that Lwanja wrote, "check vital signs regularly" but couldn't find even a single set of vital signs since the time of her surgery yesterday. Considering that there is one postnatal nurse for close to a hundred patients, this comes as no surprise. As I was standing near her bed, the nursing matron (i.e. the charge nurse of the hospital) came and told me that someone tested the autoclave machine (the machine that sterilizes all the instruments used in surgery for both Bottom and Kamuzu Central Hospital) and found that it was actually not successfully sterilizing anything. At this point there is only one autoclave so it cannot be put out of commission until fixed. There once was a functioning autoclave at Bottom Hospital but it has not been working for some time for its intended purpose. However, like so many other things, it has gained another use, while it sits waiting for repairs, staff have been using it as a microwave to warm lunches and fries.

All I can say, with a bit of awe and horror, is that life is certainly tenacious.

Blessings

Doreen is 18 years old. She gave birth to Dalitso on the operating table on November 3, 2005. That was the last night shift I worked. Like my other nights spent at Bottom, it was an exercise in suffering - watching women in true agony without being able to assit them; my own tailor fit version of hell. I have such a clear image of Doreen, restless, in the fourth bed on the left side of the room, an IV line attached to her left arm, crying inconsolably, pleading for help, tormented hour after hour by strong contractions which failed to dilate her cervix past seven centimeters or move her baby down through her pelvis. Even by generous standards, her labor had already arrested by 4:30pm on the 2nd when I arrived, but Bottom only has one operating theatre and there was a woman with a ruptured uterus, ruptured bladder, and a dead baby ahead of her. Considering that Bottom occasionally shares one anesthetist with Central Hospital and that both the urologist and the consultant had to be called in from home, the first surgery took several hours. Unfortunately for Doreen, during that time a hemorrhaging pregnant woman arrived, bumping her once again to the back of the line.

There was nothing I could do. Every so often I would go and listen to the baby's heart, the quiet contender in the difficult battle. And, I would place a hand on her belly, feel it rise up - a stone under a thin layer of skin - as it ceaselessly tried to remove the now unwanted person from her small body. Finally, sometime after 4am, the theatre staff summoned Doreen. I went with her to receive the baby but when everyone was scrubbed and ready to begin, someone noticed that the baby's head was beginning to crown. Almost instantaneously, the theatre was vacated, leaving me alone to attend the delivery, resuscitate the baby, deliver the placenta, and suture Doreen's tear. I was annoyed by everyone's disappearance while I resuscitated the baby and Doreen lay unattended on the table. I was annoyed when I thought of them sleeping while I searched for everything needed for suturing. But, when the tasks were complete, I was grateful for their absence. I was grateful for the quiet; grateful for the uninterrupted opportunity to witness a woman falling instantly and deeply in love with her baby.

Doreen's transformation was complete. She entered theatre as a woman approaching death and left in a state of pure radiance. While it was just the three of us, Doreen smiled and talked to me rapidly in Chichewa - not at all bothered by the fact that I only understood ten percent of what she was saying. I did understand that she wanted me to name her baby and so with my foggy 4am mind, I rattled off all the Chewa names I could remember. She considered them thoughtfully and continued talking. After a while I took her and her baby boy back to the labor ward. She asked for my phone number, which I happily gave her, laughing to myself as I wondered how we would communicate without the aid of sign language. And then the work resumed. The night continued with all the expected and unexpected difficulties but every once in a while I'd look across the room and Doreen would flash me an enormous white smile.

On Thanksgiving, an appropriate day, Doreen called me. Luckily I was near a bilingual Malawian and with his help we agreed that we would meet the following Tuesday at Bottoam and that she would take me to her home. And so we did. We met at Bottom, me little Doreen, and chubby Dalitso. When I asked what Dalitso means, she said in English, "Blessings, don't you remember? You named him?" We got in my car and she directed me through familiar and unfamiliar parts of Lilongwe, arriving at last at the house where she lives with 7 people and a handful of children. On the way I learned that her parents died when she was 12, that Dalitso's father is completely out of the picture, and that she still wants to finish secondary school but lacks money for school fees.

It was wonderful to spend the afternoon with Doreen, Dalitso, and their family in the place that envelopes much of their unfolding stories. It is difficult to describe what an honor it is when someone brings me home, introduces me to their family, lets me hold their baby, feeds me, tells me I am welcome, and does it all with joy and pride. It approaches divine. I will certainly return to visit and the school fees . . . covered.